Invasive hemodynamic monitoring is routinely used in medical environments, such as operating rooms and critical-care settings, for determining volume status and cardiac function in patients. Limitations of invasive monitoring include advanced training, cost, time constraints, and potential for infectious and vascular complications. Newer sophisticated non-invasive monitoring devices for earlier detection of intravascular volume changes using plethysmography and muscle oxygen saturation may be impractical and expensive. Lack of sensitivity of traditional monitoring has prompted researchers to look for alternative means to more accurately estimate intravascular volume status.
Peripheral venous pressure (PVP) is increasingly used in the assessment of intravascular volume status. PVP accurately reflects central venous pressure, particularly in the setting of acute hemorrhage (>1000 mL). A method for dynamic measurement of intravascular volume status is cuff-occluded rate of rise of peripheral venous pressure (CORRP). CORRP allows for earlier detection of acute hypovolemia compared to traditional monitoring in animal models. The challenge is how to measure absolute PVP and CORRP in a non-invasive manner rather accurately.
Further, while seemingly simple, proper intravascular placement of the intravenous (IV) catheter is mandatory for effective IV volume resuscitation and IV pharmacologic administration. Malpositioning or misplacing of IV catheters may occur at any time during hospitalization or when a patient is in a status under the potential need of IV volume resuscitation and/or IV pharmacologic administration. Ambulatory patients may inadvertently displace the catheter, often secured with tape; patients in the operating room setting often have their arms tucked in sheets, away from the operative field, precluding inspection of the IV insertion site for signs of infiltration; pediatric patients often have IV catheters secured with devices to prevent patient tampering—also obscuring the IV insertion site.
Malpositioning of a peripheral IV catheter into the extravascular space precludes the patient from receiving necessary resuscitative therapy. Fluid administration into subcutaneous tissue or fascia may result in compartment syndrome and loss of the extremity. Tissue necrosis and gangrene may result from tissue infiltration of vasoactive medications.
Therefore, a heretofore unaddressed need exists in the art to address the aforementioned deficiencies and inadequacies.